Provider Demographics
NPI:1144224999
Name:MCCUISTON, MAIA S (MD)
Entity Type:Individual
Prefix:DR
First Name:MAIA
Middle Name:S
Last Name:MCCUISTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 IRVING ST NW STE 218
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2993
Mailing Address - Country:US
Mailing Address - Phone:734-972-4571
Mailing Address - Fax:
Practice Address - Street 1:106 IRVING ST NW STE 2300
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2959
Practice Address - Country:US
Practice Address - Phone:202-291-6257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD039436208000000X
VA0101236606208000000X
MDD72871208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA54088505619OtherJOHN DEERE
VA7390570OtherAETNA
VA010090261Medicaid
VA8127352OtherMAMSI
VA248036OtherSOUTHERN HEALTH
VA7666441OtherCIGNA
VA146389OtherANTHEM
VA010090261Medicaid